Mobilizing potential of ifosfamide/vinorelbine-based chemotherapy in pretreated malignant lymphoma

Abstract

Summary:The mobilizing potential and therapeutic activity of ifosfamide/vinorelbine-containing regimens with G-CSF support were explored in patients with pretreated malignant lymphomas. Ten patients with non-Hodgkin's lymphoma (NHL) received ifosfamide and vinorelbine, and 17 with Hodgkin's disease (HD) received ifosfamide, vinorelbine and gemcitabine (IGEV regimen), as induction chemotherapy before high-dose chemotherapy (HDT) with peripheral blood stem cell (PBSC) support. Most of the patients had been heavily pretreated with various chemotherapy regimens ± radiotherapy. The target yield was у3 × 10 6 CD34 + cells/kg of body weight in order to support the subsequent myeloablative chemotherapy. The optimal PBSC harvest occurred on days 11 and 12, with no difference in CD34 Despite the high curability rate of aggressive non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) with front-line therapy, only a small fraction of patients with refractory or relapsing disease can be successfully managed using standard-dose salvage chemotherapy. The encouraging results of high-dose therapy (HDT) with peripheral blood stem cell (PBSC) support have been widely demonstrated in both diseases.1,2 Over the last few years, PBSCs have come to be preferred over autologous bone marrow because of their ability to shorten the myelosuppressed period, accelerate engraftment of both neutrophils and platelets, and reduce blood product and antibiotic requirements. 3,4 Hematopoietic growth factors with or without high-dose cyclophosphamide are considered standard procedures for adequate mobilization of PBSCs, 5 although other combinations of chemotherapy and growth factors have also been used. A number of studies have demonstrated the superiority of the combination of chemotherapy and growth factors over either element alone, as well as the correlation between the intensity of the chemotherapy with the number of mobilized PBSCs.6-11 The best option is therefore a regimen that embodies both proven mobilizing and adequate antineoplastic activity.The efficacy of ifosfamide and/or vinorelbine-based chemotherapy as salvage regimens for poor prognosis lymphoma has also been demonstrated. [12][13][14][15][16][17][18] Gemcitabine has recently been shown to be active in heavily pretreated HD patients, with a response rate of 40% and a low level of drug-related toxicity.

ESHAP+fixed dose G-CSF as autologous peripheral blood stem cell mobilization regimen in patients with relapsed or refractory diffuse large cell and Hodgkin's lymphoma: a single institution result of 127 patients

“…Other combinations, such as ESHAP, DHAP and ifosfamide based salvage chemotherapy with superior antitumor activity are also tried with good success. 13,15,[18][19][20][21][22] There is a wide range of doses and schedules of G-CSF and other cytokines described in the literature for mobilization. 7,[26][27][28] Currently the most common is G-CSF 5-10 mg SC/kg/day.…”

“…[10][11][12][13][14][15][16][17] Lately, other combinations with superior antitumor efficacy have been tried with success. 13,15,[18][19][20][21][22] ESHAP 23 (Etoposide 40 mg/m 2 i.v. over 1-3 h, daily for 4 days, solumedrol 500 mg i.v.…”

Efficient mobilization of PBSC with vinorelbine/G-CSF in patients with malignant lymphoma

“…6 We reported earlier on the safety and feasibility of collection of PBSC after the administration of vinorelbine/ G-CSF in patients with multiple myeloma, with accurate timing of stem cell collection at day 8 after the start of mobilization. 7 Others have shown the potential of ifosfamide/vinorelbine-based chemotherapy with G-CSF for stem cell mobilization in patients with malignant lymphoma, 8 as well as the activity of vinorelbine in pretreated HD and NHL. [9][10][11] In this single center phase I/II trial, we assessed the feasibility of stem cell mobilization with vinorelbine/G-CSF in lymphoma patients.…”

Mobilization of peripheral blood progenitor cells with vinorelbine and granulocyte colony-stimulating factor in multiple myeloma patients is reliable and cost effective

“…Ifosfamide/vinorelbinebased chemo-therapy with G-CSF has been shown to mobilize successfully stem cells in patients with malignant lymphoma. 13 As vinorelbine can be administered in an outpatient setting, we also analyzed the cost in comparison to the mobilization with cyclophosphamide.…”